My First Mental Health Assessment

If you have ever had any mental health assessments, you might want to request your information under The Data Protection Act and read what reports have been written and shared about you… especially if you have been denied sickness or disability benefits. 

My first mental health assessment…

In March of 2016, I was sent for a psychological assessment at the local community mental health centre. I was very nervous about baring my soul, I felt on edge and I felt anxious about being outside in public. I was nervous but I felt that finally my GP had taken me seriously and I was about to have a serious mental health examination to assess my needs, and to be offered care and treatments.

Instead, I had a ‘nurse’ who sat drinking coffee, fiddling with a pen, looking away, asking vague questions and giving vague responses. He didn’t seem very interested in what I had to say, and as a result has reported much misinformation in ‘assessment’.

At that time of the assessment, I didn’t know at that time how to articulate and explain exactly what I was feeling or thinking properly. I hadn’t read that much about mental health. I had done some research, but not much.

I was just glad that finally someone was taking me seriously…

Or so I thought!

Below, is the report in full:

DATE: 04/03/2016

TIME: 09.30

DURATION: 60 MINS – (was more like 30 mins, max.)

STAFF TEAM: W-ACCESS/ASSESSMENT

STAFF MEMBER: xxxxxxxxxx (HPC, NURSE)

ORIGIN: ACTIVITY RECORDING

TYPE: CARE ACTIVITY

REASON: CARE EVENT DETAILS

DOCUMENT:

Patient attended for her initial assessment following GP referral and screening.

Patient was refereed to AAT due to opting to discontinue her Citalopram in June 2015 and when represented in October with apparent low mood the GP reinstated Citalopram, initially at 10mg only. Combined with this was apparent suicidal ideation (there is a recorded history of several overdose attempts and one occasion whereby patient reports she chose to let herself fall down the stairs, sustaining a bleed on the brain). Patient was screened in February by myself and at the time she presented as passive-agressive and often unable to articulate what was going on for her.

Today at face-to-face assessment, patient initially presented as relatively euthymic and amenable in mood however as time progressed and was challenged over responses that were not fitting with reported history or what she had just said earlier, her mood was interchangeable between irritable and quietness, miserable and sullen. The apparent difficulty in articulating responses to questions felt clinically as though she was not being entirely genuine and the account she was offering was not entirely believable, with regard to her intonation, her hesitancy, her evasive eye contact when questioned, general tone and responses sounding particularly generic.

(Isn’t this evidence of formal thought disorder (FTD)? I was quite clearly having trouble articulating how I felt because I had never been completely open and honest with anyone, at all, about my mental health. I was very anxious, so of course I wasn’t making eye contact. I was unprepared, I didn’t know exactly how I felt so how could i articulate it? I was coming to terms with the fact that I might have a serious mental health condition. I wanted the nurse to give ME answers! My answers probably did sound generic, because I didn’t know any other terms to use, or understand any processes that happen with mental illnesses. I had read a little bit about mental health when I was reading about how to overcome depression. Maybe, I had already noted his generally vague style of questioning and realised that I was not going to be taken seriously…maybe.)

At one point in particular when questioning about self-reported “mood swings” I detected a slight and subtle smirk upon her face whilst she thought I was not looking, but taking notes.

(Why would I smirk? Maybe I did, but not for the reason that he is implying. I do remember at this time that I was feeling the effects of hyper-arousal / hyper-sexuality. Possibly why I ‘smirked’. 

I remember, after I went back to my GP and mentioned again about the Mood Swings, he questioned me ‘Mood Swings?’, with a strange manner, and I remember thinking – er yeah, you know them right?!

…Now I realise why he said that!)

Regarding the reinstatement of Citalopram 10mg end of 2015, patient reported not taking it. She stated that she had taken it for some time (inconsistently) during 2015 and she felt she had gained weight from it and that it still made her feel “depressed” and have “mood swings”. Like in the initial telephone screening, I reiterated the ineffectual therapeutic potential of antidepressants when taking inconsistently as in patient’s case and essentially how it is not a ‘magic pill’ to treat her “shit life” (to use her expression). She acknowledged this, albeit in a somewhat disgruntled manner. She is medication-free (inc. any physical meds) at the time of assessment.

(I didn’t take the Citalopram because I didn’t want more antidepressants. That’s why I asked my GP to send me for a psych assessment, for some actual treatment, not just a “magic pill”. I had been palmed off too many times with anti-depressants. They worked for a short time and then ceased to have an effect. I was there that day for an actual mental health examination, or so I thought.)

Attempted to explore “mood swings” as she expressed both that and suicidal thoughts being a primary concern. Start started telling me “at the start of the week” as an example but was then virtually unable to quantify her apparent mood changes, any identifiable triggers, subsequent behaviours/ actions and then any thoughts/ cognitions thereafter.

(I didn’t know how to explain my mood changes, except to say ‘one day I will wake up feeling like this, and then next day I could be feeling like that’… At the time of this assessment, I had little idea what a trigger even was. Nobody has spoken to be about what a trigger is, or explored triggers with me at all. All I knew was that my moods were up and down, and I was feeling pretty shit. And I had been feeling like this for years. I didn’t know what it was. I was hoping he would tell me that!)

I intentionally used several terms to aid her attempt at describing such apparent experiences, to which then predictably she used these terms with no other explanation or further description. In essence, patient reported that for the past 15 years (since the change in parenting – see previous assessment by Crisis Nurse) she goes through indescript periods of getting angry and losing her temper, most recently smashing up her mobile phone as a consequence.

(I have never described my father abandoning me as ‘a change in parenting’. It was one of the most traumatic times in my life. The phone smashing up was at the beginning of 2015, while my father’s daughter was staying with me after the TBI. Hardly recent as this assessment was in March 2016.)

Often feels frustrated (at life, her life) and potentially unable to process and regulate such normal emotions and feelings and then withdraws being on her own. She said she “can’t really say” anymore about it. This in part felt an inability to describe her own emotions but also by her tone and facial expressions potential in-genuineness in her narrative, for whatever motive. I asked what she wanted from the mental health assessment today, she was unable / unwilling to answer – “I don’t know what I want”.

(I was by no means unwilling to answer any of his questions, I was there to answer questions and get answers. I simply did not know how to explain my emotions. I had suppressed them for so long, I wasn’t even sure what I was feeling. And so far, whenever he mentions my ‘tone’ it implies I was lying. He is clearly not very good at reading ‘tones’. Or had he already decided that I was a liar? I wonder.)

Suicidality

Reported to have been planning on taking her life tomorrow – Saturday. No apparent anniversary / special meaning attributed to the date, but only because her nine year old daughter, will be at her biological Father’s for the weekend and not with her. However, she reports she handed-over her undisclosed amounts of Co-Dydramol, Ibuprofen and Co-Codamol to one of her male friends (not Dan who attended today).

(I reported that my daughter was going with her father, as she did every weekend and that I would be able to do it then. I was not happy about these suicidal thoughts, hence why I pushed my GP for a mental health assessment. I was stock-piling tablets. I read online that if you are feeling suicidal and have impulsive tendencies, it’s best to get rid of all triggers and enabling objects etc that can aid with the suicide. So I did. I gave literally all of my tablets that I had in the house to my friend, Dan. He states there “not Dan, who attended today”. It was not my friend Dan who attended with me, and yes, I did give those pills to him. Clearly the ‘nurse’ was not listening.)

She gave no reason initially as to why she had decided to do this – not even due to her daughter.

(It is on every doctors report, or should be, when I have been asked what stops me from committing suicide, I say ‘my daughter’ 100%. This is either misinformation being reported by the nurse, a lie, or if I was quiet, that itself is surely a sign of depression and FTD? I feel that the nurse had  already formed another opinion as to why I did not answer…)

She reported that although she had had enough of her life, she does not want to live but has to because of her daughter. Her tone detected at this point appeared somewhat bitter.

(This is completely untrue. I felt absolute remorse and guilt and pain about wanting to die because she would be without me. But at the same time I thought that she would be better off without me. I was in emotional turmoil. I was not bitter, I was engulfed in shame and pain.)

I enquired as to whether her daughter was a mistake – she did not answer and physically moved her seated position to face away from me. I let the silence continue for a moment to see if patient would respond. She stated that she feels “my daughter could do better than me for a mother”.

(I did say that, but not in the manner of which the nurse is quite clearly implying. My daughter came along after a miscarriage only a few months prior. She was not a mistake. Her father and I were overjoyed when we found out that I was pregnant with her.)

This was reportedly planned and she had the access and means to carry this out. She however chose not to, for reasons unknown. She acknowledges that she can be impulsive  – particularly in respect to overdoses (see previous assessment).

(I however chose not to kill myself, and to instead reach out to friends and to seek medical help… quite obviously as I was sat speaking to a mental health nurse having a psych assessment / evaluation.)

*We talked about her daughter for some time. Her daughter still apparently nine years of age despite being recorded in previous A&E assessment 12 months ago her also being nine. Patient didn’t make any overt reaction when I pondered this out aloud.

(I actually said that it didn’t surprise me that the notes were wrong as the nurse at the Crisis Team wasn’t even listening to me and tried to force me to go to a domestic violence victim support group and alcoholics anonymous. I did not need either of those things. I’d told the nurse the truth which she has rearranged to suit her own agenda!)

She lives with her Monday to Friday and with her Father at weekends. I asked how is her daughter’s general well-being at this time, is she well? Patient reported she was. I asked how did she settle back into school last year following patient removing her to apparently a need to make patient feel safe (recorded in previous assessment / safeguarding).

(I have literally never said that I took my daughter out of school to make myself feel safe! What does that even mean, what is my daughter, superwoman? I do feel safe when I am with my daughter, she is a huge comfort to me. She also feels safe when she is with me and I am a huge comfort to her too. Misreporting.)

Patient reported that she has been off school since October 2015 and remind off school to date. I asked her to repeat this, to clarify, to which she said the same again. Her reason apparently for removing her daughter from school was so that patient can home-school her – but with absolutely no rationale given as to why. Asked if she is due to go back to school – patient stated as soon as possible, but to a different school. Patient states that they do ‘do learning’ together. I asked what her daughter thinks of this, does she miss her friends, ask questions why she’s different to her friends.

(I felt that the line of his questioning wasn’t appropriate for my mental health assessment, or his business. He was very invasive and dismissive of what I was saying. I remember trying to shut him down about my daughter’s education. The education board knew that I was homeschooling my daughter. All appropriate authorities knew.

Why would my daughter ask why she was different to her friends when I took her out of school with HER permission? This is implied child abuse. And she saw her best-friend from school often, as I became good friends with her mother! The girls stayed at each others houses often.) 

She was unable to fully give any substantial responses saying that she likes it and often sees her friends. “She’s a good girl” Patient added, unprompted.

(What reference is that “she’s a good girl?” It comes up twice during this report. Is that another implication of child abuse? I wonder.)

I asked what did Educational service think of this – she reported “nothing, they sent a letter home acknowledging me home-schooling her”. I enquired whether social care are involved and what they say/ what their plan is. She stated they are not involved/ never have been.

(I said they have never been involved with the schooling. He has taken this comment completely out of context. Probably wasn’t listening properly, again.)

Patient’s whole manner felt shifty and in genuine throughout this conversation.

(Because I was there to speak about my mental health, not homeschooling. His questioning seemed irrelevant and prying.)

She asked me to return to asking about her own wellbeing. I advised I have a duty of care to the minor when a parent is having a mental health assessment. She acknowledged this.

I asked what does her daughter do during the day when patient is reportedly sometimes unable to get up from bed due to apparent depressed mood or when patient reportedly gets angry and smash inanimate objects (she denied hitting her daughter). Patient reported again that “she is a good girl” but will probably soon realise what her mum is like.

(Why is ‘(she denied hitting her daughter)’ written directly after the statement about me smashing up inanimate objects? And why is it in brackets? What reference is that even to smashing up inanimate objects? It seeems the nurse had his judgements formed early on in the assessment. And why does it say again “she is a good girl” like that? There is a blatant implication of child abuse here, linking the smashing of objects with denial of hitting my daughter. AND THEN it implies that my child will soon know that she is being abused… ‘know what I’m like’…! When I said that she will know what I am like, I meant that I am a mess and not strong, a failure. I felt like a failure to her.

I don’t hit my child. I used to smack her when she was younger as a punishment, but when she was about 6/7 years old, she cried and said ‘mummy you shouldn’t do that to me, you hurt me’… I thought, she’s right. What right do I have to hit her? I am teaching her that it is OK to hit and smack. So, I stopped ‘smacking’ then and there. I so shout at her from time to time, what parent doesn’t? But actually, I am extremely patient with my daughter. I show her compassion instead, and teach her right from wrong with words.)

I asked if having her daughter at home every day during the week is tiring and exhausting, she said it was not, but comforting. Her daughter plays the X-Box for the most part she then later said.

(The X-Box response was to his question ‘What does your daughter do when you are unable to get out of bed’.

The answer that I gave saying that it was ‘comforting’ to have her there… I’m like, and what? There’s an implication there, of what I am not entirely sure. It is irrespective to the question. The answer was no, it was not exhausting at all, I liked having her there. She is a comfort to me.)

Enquired as to where her daughter is currently whist patient is sat with me for the purposes of a mental health assessment, she reported “she’s with a friend”.

It is worthy to note how this was a challenging interview*. Patient did not offer anything unless it was asked of her, and nothing was explicitly explained of described further by her. Such a manner was felt not to be in the context of apathy, a flat or blunted affect or in a dissassociative manner. It felt for the most part ingenuine, for whatever motive.

(WRONG. I was completely dissociating. I could not answer coherently and properly, because I was experiencing symptoms of depression and anxiety. I remember during that interview that I was not offering anything unless it was asked of me, because I didn’t know what to say. I am linking the fact that as he wrote that paragraph under the parts about my daughter welfare, he is insinuating that I was withholding information about her and myself, and lying. Quite clearly, as it states above.

*Interview? I thought it was a mental health examination?..)

Patient reports drinking just a few bottles of wine per week. Asked how much cannabis she smokes (knowing she reported daily use historically). She initially said “sometimes” and then backtracked and said daily. Asked to quantify – 2/3 joints per day to “get by”. I asked if she was under the influence at this time due to her pal our, slightly bloodshot eyes, pupil constriction (not dilated) and occasional odd remark. She denied this, and denied any other use of substances, further blaming it all on a cold.

(I did actually have a cold, and I actually was not stoned. I hadn’t touched cannabis that day! And I never would prior to any kind of assessment / examination or meeting)

Interestingly, during earlier questioning around ADLs and sociality, for the most part she reported rarely going out but she let slip about going out with friends of a weekend and “doing whatever”.

(Let slip?…I didn’t know it was a secret. I let the cat out of the bag. I’m shit at keeping secrets!

I barely went out anywhere. If i did visit friends we would just chill out. I don’t quite know what is being implied there when he says that I stated I go out and “do whatever”… drugs? It says just above that I denied any other substances, so probably yes, he means drugs. More assumptions?)

Self-reported tinnitus and memory problems sustained from when she threw herself down the stairs circa 2014. No corroborary medical history re tinnitus and when exploring MSE she appeared unable to identify how the tinnitus affects her.

(Actually there is evidence of the tinnitus as I was under the ENT specialist at my local hospital…

But who cares about evidence when you’re in a position of power and need to get your lies and assumptions across?)

Reportedly “suspicious” of all medications – inexplicit as to why and offered that her daughter had not had antibiotics since she was three. Unknown relevance to conversation at this point.

(Quite clearly and obviously the relevance is because we were talking about how I feel about medications. It is true, my daughter has not had any antibiotics since she was about three, and neither have I. 

But what is the relevance to the nurse putting that in his report? I wonder.)

Support- friends, Dan (male friend) who attended today (waited in reception, told by patient to stay there) and other friends able to recently open up to when feeling low or ‘suicidal’.

(No, it was not Dan at no point did I say that it was Dan)

Has Mum and Step-Dad also. No reported family mental illness that she knows of. No contact with her biological father since she was aged 15 when she moved to her mother’s. “Mind Fuck” of a childhood reported because the reported bitterness of her father.

(Mind Fuck of a childhood reported due to the emotional neglect and abuse that came from the bitterness of divorce, and the abandonment by my father when I moved to my mother’s house.)

No reported sexual abuse but emotional neglect. Reported no exposure to current Domestic Violence (as reported in 2015).

(The Crisis Team psychiatric Nurse misreported the domestic violence in March 2015. I write about this in ‘Crisis: March 2015’.)

Reports was working behind the bar in the local pub before Christmas but had to quit due to apparent “social anxiety” (her words) – could not explain the impact of this.

(I wasn’t working behind the bar, I was working in the kitchen as a chef. I told him that. I also told him that I was having memory problems and problems with my ear with the tinnitus and hyperacousis, and that I was having feelings of social anxiety… I did not know how to articulate properly the social anxiety. I just knew that it made me withdraw.)

Interestingly, prior to her assessment, I watched her laughing with her male friend outside walking past several passers-by and then sit in the reception with others nearby laughing and poking her male friend, overtly oblivious to everything around her at that time.

(Next assessment I will go dressed in black, sit in the corner of the sitting room, slitting my wrists or something… I remember that I was feeling very anxious and my friend, who was NOT Dan, was trying to cheer me up and relax me by making me laugh, which he did – to a degree.)

End of December 2015 also was reported by GP to have been when she felt “depressed” and “suicidal” and off Citalopram.

Currently repays rent arrears following County Court Judgement. Does not feel she has the confidence to work currently however obscurely said that she could “network” to get back into DJ’ing (out of context) as was her intonation, found to be incongruous.

(I did not say this at all. I said that I would like to get back into DJ’ing and have the confidence to go back out there and do some networking!)

Upon mental state examination (MSE), nil evidence / report of passivity phenomena, nil evidence of formal thought disorder (FTD), nil evidence / report of hallucinatory experiences or any other positive or negative symptomatology consistent with psychosis. Reports to be someone “quick to react” – in the context of misinterpreting what others have said / intend. Feels as though she “second guesses” everything and “reads into what people say”.

(I said that at that time I was feeling paranoid and felt like I was second guessing everyone. I said that I read too much into what people say)

Denies abnormal thoughts or belief systems. Denies any racing unwanted thoughts. Sleep is variable; often broken, sustains 5-7 hours average. Apetite fine. Nil evidence of affective or neurotic symptoms. Her affect was occasional incongruent with her manner and both incongruent to what she was saying. Denies thoughts, intent to harm self by DHS or others. Suicidality reported to be “like a dripping tap” and “always in the back of my mind”.

Does not appear to be in contact of a treatable severe and enduring mental illness following assessment today. More so in the contact of traits and states consistent with an emotionally unstable personality disorder (not diagnosed).

My concerns are currently in relation to patient’s daughter as to patient’s report that she remains off school for no apparent sound reason and that social care and education are not involved.

In addition, gut-feeling, something does not fit with patient’s story-telling.

(Gut feeling? Story telling? …Are these medical terms?)

PLAN

Inform GP of outcome of assessment and forward a copy with the consideration of started an alternative SSRI but to be mindful of patient reported para-suicidality. Patient agreeable to this.

Will discuss with Therapies in-reach team about some emotional regulation work / low-level group work, possibly encompassing self-esteem also as Healthy Minds are not clinically indicated. Patient agreeable to this. This may act as a means of further monitoring also.

I will be contacting social care to enquire / relay my concerns around patient’s daughter reported today as to whether she is known to social care. If not known, I will be raising a SETSAF1.

(I will be obtaining a copy of that SETSAF1 form / referral under the Data Protection Act.) 

………. ………. ………. ………. ………. ………. ………. ………. ………. ……….

Well… That ‘interview’ went well! 

I haven’t complained about this yet, but I will, once I have received all of my mental health records that I have requested from my doctors, social service and the hospital. As there will no doubt be other complaints and alterations to be made. 

I managed to get a copy of that assessment by chance one day when I went to see the duty GP for something totally unrelated.

The lies and the implications within this assessment sent me spiralling. It was a huge trigger for me!

Luckily, I had already spoken to the Doctor about this assessment and said that I felt it did not go well for me (I didn’t quite realise the extent of how well it went!). I demanded that my GP stopped sending me to see NURSES and sent me to see an ACTUAL PSYCHIATRIC DOCTOR.

He did. Finally.

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